Summary: Mr C complained about the Council’s handling of his father’s respite and subsequent permanent care placements. We found fault in how the Council handled Mr X’s transition from respite into permanent care. There was no other fault, or significant injustice on other parts of the complaint. The Council should apologise and make payment to Mr C to acknowledge the distress and time and trouble its fault caused him.

The complaint

1. The complainant, whom I shall refer to as Mr C, complained about the Council’s handling of his father’s (Mr X) care arrangements. He said it:
• failed to find a single suitable home for Mr X’s respite care;
• promised to move Mr X from respite to permanent care, but did not do so, and failed to make contact with Mr C’s preferred care home when requested;
• failed to communicate properly with the family regarding care costs; and
• failed to reply to emails and calls when Mr X was in permanent care.
2. As a result, Mr C said he and Mr X experienced distress and uncertainty, and he had time and trouble to bring his concerns to the Council’s attention.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

6. As part of my investigation, I have:
• considered Mr C’s complaint and the Council’s responses;
• discussed the complaint with Mr C and considered the information he provided; and
• considered the information the Council provided in response to my enquiries.
7. Mr C and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
8. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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What I found

Relevant law and guidance

Care assessments

9. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
10. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Choice of care home

11. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions.
12. The council must ensure:
• the person has a genuine choice of accommodation;
• at least one accommodation option is available and affordable within the person’s personal budget; and,
• there is more than one of those options.
13. Annex A of the Care and Support Statutory Guidance 2014 (“the Guidance”) sets out that a person will have the right to choose the particular provider or location of a care home, subject to conditions. It says that in these cases, councils should make sure there are clear and transparent arrangements for choice and for any ‘top-up’ arrangements.
14. It also says that a person’s choice must not be limited to settings or individual providers with which the Council already contracts with or operates, or those that are within the local authority’s geographical boundary. It must be a genuine choice across the appropriate provision. Only when a person has chosen a more expensive accommodation can a ‘top-up’ payment be sought.

What happened

15. In 2021 Mr X was living in his home with his wife. He had care and support needs which his wife, Mr C and Mr X’s daughter supported him with.
16. In summer 2021 Mr X’s wife became unwell and was hospitalised. Mr C and Mr X’s daughter were struggling to provide the support Mr X needed and asked the Council for help.
17. The Council arranged for a service to provide Mr X with care in his home at intervals during the day. However, Mr C and the Council’s care service agreed he needed more support due to risk of falls and managing his care needs at times when care was not provided. The Council and Mr C agreed respite care for Mr X should be arranged.
18. The Council checked its system for availability within several care homes which it normally commissions. However, none of them had space available for Mr X. It then contacted other care homes in the area which were registered with the Care Quality Commission (CQC) and had services which could meet Mr X’s identified needs. It also extended its care support in Mr X home.
19. Two care homes responded to the Council and said they had space and could meet Mr X’s needs. The Council spoke with Mr C and offered the two care homes for respite;
• one was rated good by the CQC, but its rates were higher than the rates the Council’s would pay. It had space for Mr X three days later; and
• the other was rated as requiring improvement by the CQC but would accept the Council rate. It could accept Mr X the following day. Mr C rejected this option as he did not find it suitable for Mr X’s needs.
20. Mr C also told the Council about another care home (Care Provider Y) which he had found and believed would be the best option for Mr X. The Council made contact with Care Provider Y.
21. Shortly after, Mr C told the Council about a further care home (Care Provider Z), which he had spoken with and confirmed had space for Mr X. Its rates were above the Council’s rates, but Mr C said he agreed to pay a top up fee to enable the respite care.
22. Mr C arranged for Care Provider Z to provide respite for Mr X for two weeks, and a further week funded by Mr C as part of the top up fee. The Council arranged payment for the respite care it had agreed to.
23. Mr X moved into the respite care with Care Provider Z two weeks after the initial request was made.
24. The Council had further discussions with Care Provider Y, which said it could offer a placement to Mr X for residential care. However, this did not happen as Mr X’s long term care needs had not yet been assessed.
25. In response to the Council’s request for financial information about Mr X circumstances, Mr C shared information and bank statements with the Council.
26. The Council asked Mr C for more information to be able to complete its financial assessment. This included whether Mr X’s wife would return to their home, and for evidence Mr C had Power of Attorney to manage Mr X’s property and financial affairs. The Council’s finance team also called Mr C but was unable to reach him.
27. Mr X’s wife died in early July 2021.
28. The Council provided its financial assessment three days after he provided the financial information it requested and spoke with him by phone. It shared:
• Mr X’s care costs for the 12-week property disregard period;
• Mr X’s care cost for the period after the disregard period. It explained his home would need to be valued at this stage and he would be self-funding his care; and
• leaflets for help with paying for care and advisory information booklets.
29. At this time, the Council also became aware Mr C had paid Care Provider Z’s invoice in full for the three weeks of respite care and asked it to refund Mr C for the two weeks the Council should pay. It also noted it had to complete Mr X’s Care Act Needs Assessment.
30. A few days before Mr X’s respite placement was due to end, the Council spoke with Care Provider Z. It told the Council it had had discussions with Mr C about Mr X staying with it under a permanent care placement.
31. The Council Finance Team spoke with Mr C shortly before the respite placement ended and confirmed the cost Mr X should pay to Care Provider Z as set out in its recent financial assessments.
32. Mr X stayed with Care Provider Z under a permanent placement.

Mr C complaint

33. Mr C complained to the Council about its handling of his father’s (Mr X) care arrangements in summer 2022. He said it:
• failed to find a single suitable home for Mr X’s respite care, which meant he and Mr X’s daughter had to support their father for longer and had to find care placements themselves before respite care was put in place;
• promised to move Mr X from respite to permanent care, but did not do so, and failed to make contact with Mr C’s preferred care home when requested. He said as a result he had no other option than to continue the placement with Care Provider Z;
• failed to communicate properly with the family regarding care costs, which meant Mr C was unsure about the care cost contributions the family had to make; and
• failed to reply to emails and calls when Mr X was in permanent care.
34. In response the Council partially upheld Mr C complaint. It explained:
• (Respite care) the supply for respite services were limited and its team acted in a timely manner. It said it offered two suitable respite placements which Mr C declined. Mr X was subsequently placed in Mr C’s preferred respite care;
• (Permanent care) it confirmed it had previously contacted Care Provider Y. However, it apologised for its Social Worker’s failure to progress Mr X’s potential move to Care Provider Y as Mr C preferred and to contact him as agreed. As the family then decided to keep Mr X with Care Provider Z, it could not do anything else;
• (Care costs) it found it had explained it would fund two weeks of respite care for Mr X, and it had shared its financial assessments and information with Mr C before this ended. However, it apologised for the mix up with the payments as Care Provider Z had invoiced Mr C. The Council had since paid the care provider and asked it to refund Mr C; and
• (Communication) it accepted there had been some contact from Mr C it had not responded to in a timely manner but found its Social Worker had remained in communication with him by phone and through emails.
35. Mr C was not satisfied with the Council’s response. He asked the Ombudsman to consider his complaint.
36. Mr X remained in with Care Provider Z until January 2022 when he died.

Analysis and findings

37. Mr C complained about events which occurred more than 12 months before he brought it to our attention. His complaint is therefore late. However, I have found it appropriate to exercise my discretion to consider his complaint as he had to deal with the loss of both Mr X and his mother during this period.

Respite Care

38. The Council agreed Mr X should receive respite care in June 2021. It therefore had a duty to provide Mr C with genuine options for suitable respite placements for Mr X within or outside its area without delay.
39. It took two weeks before Mr X was placed in respite care with Provider Z. However, I have not found the Council at fault for causing a delay. This is because the evidence shows it:
• made enquiries with care providers it normally commissioned and others for availability, which did not have capacity to accept Mr X;
• found two care placements which offered placements for Mr C within a short period of time. I understand Mr C subsequently spoke with the placements, which then told him they could not meet Mr X’s needs or would not accept the council rate offered;
• Mr C contacted Care Provider Z, which offered Mr X a respite placement. He told the Council which agreed to fund two weeks respite with Care Provider Z;
• sent a referral to Provider Y, but did not follow this up as Mr C had confirmed Mr X would be in respite care with Provider Z; and
• put in place at home care support for Mr X to support him with his needs until his respite placement was in place and a care needs assessment could be completed.
40. Mr C said the two care placements the Council offered were not suitable for Mr X as the placements subsequently told Mr C they could or would not accept Mr C. However, these were both registered with the CQC to provide the support the Council had been told Mr X needed and told the Council they could offer a placement. I have therefore not found evidence these were unsuitable to meet his needs at the time, or that the Council should have known these were unsuitable.
41. I understand Mr C wanted what was best for Mr X, and he had the right to ask the Council to find alternative care placements in line with his wishes. However, Mr C had already arranged an offer with Provider Z when the Council became aware the two providers it had found could or would not accept Mr X.
42. While I acknowledge Mr C and Mr X’s daughter struggled to support Mr X until his respite care was in place, I have not found the Council at fault for how it handled this.

Permanent Care

43. The Council had agreed to provide respite care for Mr X for two weeks, and it was aware Mr C had arranged a further week of support.
44. Following Mr C’s complaint, it agreed it had failed to progress his request for Mr X to be placed in permanent care with Care Provider Y in a timely manner before his respite care came to an end.
45. The evidence shows Care Provider Y had told the Council it could accept Mr X shortly before the Council’s funded respite placement came to an end. However, the Council’s allocated Social Worker did not follow this up and make the necessary arrangements. I therefore found the Council at fault for failing to ensure the wishes of Mr C was put in place and Mr X be placed with Care Provider Y.
46. In addition, the Council had a duty to complete a Care Act Needs Assessment of Mr X within a timely manner. However, it had not arranged an assessment four weeks after Mr X had been referred to it for support. This was fault as the Council should have arranged the assessment with urgency and without delay to ensure his assessed needs were fully known.
47. The Council has since put in place support for the Social Worker’s casework, and staff are supervised monthly.
48. There is no evidence to suggest Mr X’s care needs were not met when his respite placement became his permanent placement. However, I am satisfied the Council’s faults caused Mr C distress and uncertainty. He also had unnecessary time and trouble to contact the Council and the care providers.
49. I cannot remedy any distress Mr X may have experienced as he has since died.

Care Costs and communication

50. Mr C said the Council failed to properly explain Mr X’s care costs with him, including what the Council’s rates with the care provider was.
51. The evidence shows the Council shared its financial assessments with Mr C shortly after he had provided the information it needed to complete the assessment. It also shared leaflets and booklets for further information and advice about care costs. This was shortly before the Council’s funded respite care came to an end.
52. I am satisfied the Council’s financial assessment and calls with Mr C properly explained the care cost’s Mr X would have for his permanent care. This includes the 12-week property disregard period and after this period ended.
53. The Council’s financial assessment did not show what the Council’s agreed rate with Care Provider Z was. Normally, this would not be an issue as Mr C was told what contribution Mr X had to make. However, as he had arranged a further week of respite care for Mr X and was considering a top up arrangement with a different provider, this meant he did not know what the costs would be.
54. Although information about the Council’s rates with care providers is publicly available on its website, Mr C had not received a response to his questions about this. This was fault. The Council has already apologised for this, and I am satisfied this was enough to remedy the injustice this caused Mr C.
55. Mr C and the Council had no or limited communication after Mr X’s placement became permanent. There was therefore no further fault or injustice at that time.

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Agreed action

56. To remedy the injustice the Council caused to Mr C, the Council should, within one month of the final decision:
1. apologise in writing to Mr C, and pay £200 to acknowledge the distress and uncertainty the Council’s faults caused; and
2. pay Mr C an additional £100 for the time and trouble he had to contact care providers and bring his concerns to its attention.
57. Within three months of the final decision the Council should also:
1.  
2.  
3.  
4. remind its Financial Assessment Team to include the Council’s rates with care providers in its communication with individuals and their representatives when arranging care placements. This is to ensure individuals has a clear understanding of their care costs at the time and any potential top up payments; and
5. remind its staff to progress permanent care placement without delay before respite placement ends in line with wishes of the person care for, or their representatives.
58. The Council should provide us with evidence it has complied with the above actions.

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Final decision

59. I have completed my investigation with a finding of fault in how the Council communicated and handled Mr X’s transition from respite care into permanent care. There was no other fault, or significant injustice on other parts of the complaint.

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Investigator's decision on behalf of the Ombudsman